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I have the distinct honor of introducing Dr. Michelle Riba, President of our esteemed American Psychiatric Association. I will begin her introduction with a story. I first met Michelle in 1993 when we recruited her for a position at the University of Michigan. As the interview closed, I looked at her and asked, “How long do you suppose it will take before you become President of the American Psychiatric Association?” Despite preconceived stereotypes among some in our society about psychiatrists, I had no crystal ball. Michelle simply radiated leadership 12 years ago even as she does now. A few selected examples illustrate her wide-ranging skill sets. First, Michelle is a world leader in education. Teaching appears to be in her genes. Indeed, before becoming a psychiatrist, she taught high school chemistry and biology. At the University of Michigan Department of Psychiatry, she served first as our Director of Residency Education and later as Associate Chair for Education and Academic Affairs. She has received APA’s Nancy Roeske award for excellence in medical student education twice and served as President of both the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. When the Institute of Medicine compiled a team to help remedy the severe shortage of academic psychiatry clinical investigators, Michelle was appropriately asked to be a member of that elite group. As APA President, she has played a key role in the National Psychiatry Training Council, which the National Institute of Mental Health established to implement the Institute of Medicine guidelines. I have the privilege to co-chair that group, a collection of ALL key players in the field, and as a side commentary, it is my hope that all members of our profession will recognize and support this vitally important effort to create a new generation of academic psychiatrists. In clinical domains, Michelle excels in consultationliaison psychiatry. Some teach and talk collaboration; Michelle exemplifies it. At Michigan, she led the development of the PsychOncology Program and serves as its Director. The Ford Motor Company awarded her the “Partners in Health Award”—the Cancer Center’s highest annual honor—for this program. I recently asked Dr. Riba to assume a new position as Associate Chair for Integrated and Collaborative Services in our department. This new position requires her to lead, develop, organize, integrate, and manage new opportunities for clinical, educational, and research collaborations among our Department of Psychiatry and the Depression Center, on the one hand, and other Centers of Excellence within our health system, on the other. Without such bridge building, it is my belief that psychiatry will not succeed in forging and solidifying the partnerships that enable our most promising tremendous scientific advances to be translated into the mainstream clinical delivery in our nation’s complex health system. Academically, Dr. Riba is a prolific, practical, and powerful voice. She has over 100 peer-reviewed articles, chapters, and abstracts and has edited or co-edited more than 25 books. She is an administrative legend. She prioritizes, organizes, and accomplishes, quietly juggling multiple projects without ever appearing to be multitasking, and is not afraid to dream. She also is not afraid to take positions that firmly defend values of importance to our patients and families and that emphasize the role of psychiatrists in their care. For example, she recently launched a task force on college mental health, emphasizing the essential participation of psychiatrists in the delivery of care for our student populations. Finally, Michelle is a wonderfully balanced individual: a dedicated daughter, a remarkable spouse to Artie, and a devoted Mom for Elisa and Erica. In essence, she does it all. The American Psychiatric Association has been privileged to be led by this President, Dr. Michelle Riba.

Using the same questionnaire, the authors surveyed drug use at a military installation in 1970, 1971, and 1972. Oven the three years, the total percentage of respondents reporting previous drug use increased: the amount of use and number of current users also increased. For most drug types, the increases occurred between 1970 and 1971; heroin use, however, increased each year. The authors question the usefulness of specialized short-term drug treatment programs.

Biological markers of affective disorders have not been studied intensively in patients with secondary depression. An elderly woman with severe delusional depression secondary to thyrotoxicosis was monitored with weekly dexamethasone suppression tests (DSTs) and three sleep electroencephalography (EEG) evaluations. She received treatment only for her thyrotoxicosis, but her depression resolved completely. The serial DSTs were normal throughout her depression, consistent with the specificity of this test for primary endogenous depression. The sleep EEG erroneously suggested a diagnosis of primary depression but effectively monitored clinical improvement. Biological markers may have applicability in evaluating and monitoring patients with secondary depression.

There is continuing debate about what child psychiatry experiences should be included in a general residency. The author describes the program at the University of Michigan in an effort to provide some insights into the interface between child psychiatry and general residency training. This program is unique in several respects: a 12-month rotation in child psychiatry is offered, and the faculty size and budget of the youth services are comparable to those of the adult services. A survey of all residents and faculty pointed up numerous disagreements as to the length of the rotation and priorities in curriculum. The author discusses the influence of the various competitive processes on the educational program.

Among 83 hospitalized adult psychiatric patients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms, felt that their physical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels, inhibits phosphodiesterase breakdown of cyclic AMP, and sensitizes receptor sites, association of caffeinism with both anxiety and depressive symptoms is possible.

The authors describe three patients who developed withdrawal symptoms after discontinuation of antidepressants. Their symptoms were successfully treated with atropine. Central cholinergic overdrive is implicated in the genesis of the symptoms.